Therapy trainees and developmental changes in the alliance

Abstract

This qualitative, retrospective study examined the experiences of a small group of clinical psychology graduate students and supervisors. The study focused on the ways in which trainees at three points in training think about and work clinically with the alliance. Research has repeatedly demonstrated that the alliance is an important factor related to therapy outcome across several therapy modalities. However, there are few published reports investigating the relationship between therapist experience level and the alliance. Within this small body of literature, there are no published studies that examine changes in how therapists-in-training conceptualize and work clinically with the alliance at different points over the course of training. ^ Participants were 10 internship-level clinical psychology graduate students, and 3 licensed clinical psychologists who had supervised therapy trainees at three different levels of experience: (a) the first year of seeing clients, (b) the second and/or third years of therapy experience, and (c) the internship year(s). The respondents participated in an in-depth interview that focused on their experiences with the alliance at each of these three points in training, and their sense of changes in the alliance over the course of training. ^ Qualitative analyses of the interview data revealed several trends. The participants noted that their alliance conceptualizations, or those of their supervisees, became more complex over the course of training. Additionally, they paid more attention to the alliance over time. The interviewees talked about several factors that they believed were important to the development of alliance-related skills over the course of training. These included the trainees being less anxious and more confident, more comfortable and skilled at discussing the therapeutic relationship with their clients, and more able to detect and manage ruptures in the alliance. Finally, suggestions are offered regarding strategies for teaching therapists about the alliance. ^